Yaroslavl State Medical Academy

The paper explores the role of professional ethics in establishing moral, value-based foundations, and modern pharmacy guidelines. The topic is relevant because compliance with ethical and deontological principles is an essential component of the pharmacy profession that ensures provision of high-quality pharmaceutical care as the primary task. Taking into account the requirements of regulatory documents and professional standards, the objective necessity of including a specialized discipline in 33.02.01 Pharmacy education has been reviewed. This discipline introduces students to the specifics of pharmaceutical ethics and deontology. The experience of developing and implementing the discipline of Ethics and Deontology of a Pharmacist at Yaroslavl State Medical University is described, its purpose and objectives are formulated, the topics of training sessions and approaches to their implementation are shown. The necessity of applying a practice-based approach to teaching the discipline is emphasized in order to train highly moral and socially responsible specialists who are deeply aware of their professional role in society.

Relevance . Acute intestinal obstruction (AIO) remains the focus of clinicians’ attention. The mortality rate in this pathology is 5.1–8.4 %, occupying one of the leading places among all urgent diseases. The diagnosis and treatment of patients with intestinal obstruction remain relevant. Objective . Assessment of AIO treatment results based on an improved set of therapeutic measures. Materials and methods . This study enrolled 1279 patients aged 20–90 years with various AIO course variants. The dynamics of water and electrolyte metabolism, endogenous intoxication, and treatment outcomes in different age groups were studied depending on the etiology, stage of intestinal obstruction, and volume of surgical intervention. Results . Studies have shown increasing changes in water and electrolyte metabolism during the stage of enteral hypertension, with the most significant changes in the development of peritonitis and multiple organ failure. The progressive accumulation of toxic metabolic intermediates, noted at the very beginning of the disease, also depended on the intestinal obstruction stage. The episode of adhesive intestinal obstruction was conservatively resolved in 68 % of patients. The average mortality rate among all patients was 8.7 %. Intestinal resection was required in 20.1 % of patients, which increased the mortality rate to 23.2 %. The incidence of death in cases of tumor obstruction was 3.8 times higher than that in patients with non-tumor genesis of the disease. The addition of multiple organ failure was accompanied by an increase in mortality by more than 10 times. Conclusions . In AIO, age >75 years, the need for intestinal resection, and the development of multiple organ failure syndrome are prognostic risk factors for an adverse outcome, regardless of hospitalization duration.

In contemporary endodontics, it is becoming increasingly clear that even technically perfect local interventions do not ensure predictable healing of periapical tissues. The outcome of treatment significantly depends on the patient's systemic condition, including vitamin D status and bone metabolism. This study provides a comprehensive analysis of international and Russian data on the role of vitamin D in regulating bone remodeling, immune response, and antimicrobial defense. It also examines the impact of vitamin D on the rate and extent of repair of periapical lesions following endodontic treatment. The research demonstrates that maintaining an optimal level of 25(OH)D is associated with a faster reduction in areas of destruction, particularly in patients with osteopenia and other risk factors for bone metabolism disorders. The paper discusses international guidelines for diagnosing and correcting vitamin D deficiency, as well as Russian experience with oral forms of cholecalciferol, including the domestic Osteo-Vit D3 complex. It proposes a systematic clinical algorithm for integrating the assessment and correction of vitamin D status into endodontic practice as a complement to standard protocols for root canal treatment and obturation.

Stroke is a major cause of disability for adults. Stroke-related disability can be categorized into motor and non-motor impairments. Motor impairments, such as hemiplegia, are the most noticeable sequelae. However, non-motor impairments, such as cognitive deficits, speech impairment, visual disorders, dysphagia, mood disorders, and pain can cause far greater decreases in quality of life. This article presents a case of patient S., 59 years old, admitted to the Rehabilitation Department for patients with central nervous system dysfunction. The patient was hospitalized one month after recurrent basilar artery ischemic stroke, which resulted in the severe dysarthria, severe dysphagia, right hemiplegia, and hemihypesthesia. Due to severe dysphagia and failure of food passage from the mouth to the stomach, the patient had an existing NG tube in place when he was admitted to the Rehabilitation Department. On the fifth day of admission to the Rehabilitation Department, the patient underwent ultrasonography-guided Botulinum neurotoxin type A (BoNT-A) injections into the submandibular and parotid glands bilaterally. As a result of the comprehensive treatment (speech and physical rehabilitation, botulinum therapy, drug therapy), the patient showed improvement in swallowing function: an increase in the swallowed bolus volume, a decrease in the number of choking sensations when swallowing, enhancement of the cough reflex and restoration of the pharyngeal reflex, ability to spontaneously cough up mucus, improvement of soft palate phonation, reduction in dysarthria severity, and expansion of his motor activities.

Introduction. Cutaneous melanoma is an aggressive malignant tumor of neuroectodermal origin. According to statistics, most patients begin treatment at stages 2 and 3 of the disease. This worsens the prognosis and determines the need for expanding the scope of surgical treatment. Aim: To improve the outcomes of lymphatic surgery in patients with cutaneous melanoma. Materials and methods. A total of 190 medical records of cutaneous melanoma patients is analyzed. The feasibility of escalation and de-escalation of interventions is statistically assessed. The formed prospective sample includes 43 stage 3 patients subjected to surgery by intraoperative lymphorrhea-preventing methods. Results and discussion. Prophylactic lymphadenectomy appears nonoptimal since most patients have no evidence of lymph node involvement at the time of surgery. Refusal to perform an extended intervention scarcely ever meet the requirements of oncological safety. Of 43 patients with metastatic lymph node involvement, 25 persons had involvement of only one lymph node; two or more lymph nodes were involved in 18 patients. If lymphadenectomy is not performed, a high risk of recurrence is possible in 41% of patients. Patients with stage 1 cutaneous melanoma observe a low percentage of both lymph collector damage and regional metastasis in the distant period. Stage 3 patients have an increased risk of postoperative adverse events. Sealing of lymphatic vessels, careful treatment of surrounding structures, as well as the use of optical magnification show good results in the prevention of postoperative lymphorrhea to reduce the risk of other complications. Conclusion. The type of surgical intervention in patients with cutaneous melanoma should be based on prognose analysis, considered in accordance with possible risks and, if necessary, supplemented by the use of means to prevent complications.

In recent years, artificial intelligence (AI) has become a valuable resource for medical students and healthcare professionals, allowing them to access highly specialized information and gain a deeper understanding of the subject. The use of artificial intelligence in the preparation of homework in medical schools opens up unprecedented opportunities and raises serious ethical concerns, as the use of these technologies is changing the way medical students learn and acquire knowledge. As the integration of these technologies into medical education continues, we need to understand how to ensure the integration of artificial intelligence into the educational process, while maintaining academic integrity and professional standards. In this review, we evaluate the integration of AI technology into higher medical education, how it can affect the level of teaching of clinical and fundamental disciplines in medical universities, as well as the quality of education received before future practical work in the medical field.

Subject. The microbial composition of the root canal contents in patients with chronic apical periodontitis was investigated, differentiated by the clinical course of the disease. Objectives. To identify and compare the microbial species composition in root canals of patients with asymptomatic and symptomatic chronic apical periodontitis, using highly sensitive molecular genetic analysis methods. Methodology. The study was conducted based on Yaroslavl State Medical University and Sodruzhestvo LLC. It was a single-center, prospective, case-control study that randomly divided patients with chronic apical periodontitis into two groups: asymptomatic (n=170) and symptomatic (n=130). Before endodontic treatment, the contents of the root canals were collected under sterile conditions using a cofferdam, an apex locator, and endocanal paper pins. DNA was isolated at an automated station and then analyzed for microorganisms using real-time polymerase chain reaction with specific reagent kits. To identify key pathogens, the detection rate of microorganisms was compared between the two groups using the Yates-adjusted χ² criterion and the exact Fisher criterion with a significance level of p < 0.05 for statistical analysis. Results. The polymerase chain reaction (PCR) method was used to detect microorganisms, allowing for the identification of even small species. Statistical analysis confirmed the significance of the differences between groups. The results showed that symptomatic patients have a higher detection rate of highly virulent pathogens, such as E. faecalis and F. nucleatum, and their synergistic association contributes to the formation of resistant biofilms. Asymptomatic patients, on the other hand, are dominated by streptococci and form a more balanced community. Conclusion. These findings open up new possibilities for personalized endodontic treatment based on a patient's microbiological profile.

This review analyzes modern approaches to the diagnosis and treatment of severe bronchial asthma (SBA), characterized by a transition to personalized medicine. The need to improve therapy for SBA is driven by its increasing prevalence and high resource consumption. This study examined the role of genetic polymorphisms in predisposition, disease course, and therapy response. Considerable attention is paid to pharmacogenetics, highlighting key genetic markers that influence the efficacy of basic bronchial asthma drugs (beta-agonists, inhaled corticosteroids, and leukotriene modifiers) and the possibility of personalizing the choice of biological therapy. A significant part of the review focused on monoclonal antibodies (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab), which represent a targeted approach to the treatment of SBA. The key predictors of treatment effectiveness (e. g., blood eosinophil level, IgE, FeNO, and exacerbation frequency) were analyzed for each group of biological drugs, and the importance of early initiation of therapy was emphasized to achieve maximum effect and prevent airway remodeling. Conclusion: The paradigm shift in SBA management through biological therapy, including achieving clinical remission and reducing the need for systemic corticosteroids, enables effective control in a significant proportion of patients with severe forms of the disease.